Report 2016-046 Recommendation 7 Responses

Report 2016-046: Board of Registered Nursing: Significant Delays and Inadequate Oversight of the Complaint Resolution Process Have Allowed Some Nurses Who May Pose a Risk to Patient Safety to Continue Practicing (Release Date: December 2016)

Recommendation #7 To: Registered Nursing, Board of

To ensure that BRN resolves complaints regarding nurses in a timely manner, by March 1, 2017, it should establish a plan to eliminate its backlog of complaints awaiting assignment to an investigator.

1-Year Agency Response

The BRN has established a plan to eliminate its backlog of complaints awaiting assignment to an investigator.

Completion Date: January 2017

Response Date: June 2018

California State Auditor's Assessment of 1-Year Status:
Pending

Although BRN claims it has fully implemented this recommendation, it did not provide evidence demonstrating that it has. Until it does so, we will continue to assess the status of this recommendation as pending.

Auditee did not substantiate its claim of full implementation

6-Month Agency Response

The BRN eliminated the unassigned case backlog prior to the 60-day response and continues to have no backlog of unassigned cases. 60-day feedback from auditor outlines concerns regarding Investigator workload. BRN believes additional staff will be necessary to address the level of workload assigned to investigators and is in the process of reviewing workload and staffing resources to determine what is needed.

Completion Date: January 2017

Response Date: June 2017

California State Auditor's Assessment of 6-Month Status:
Pending

BRN did not provide documentation to substantiate its claim of full implementation.

Auditee did not substantiate its claim of full implementation

60-Day Agency Response

As of January 17, 2017, the BRN has eliminated any unassigned backlog in the BRN Investigation Unit.

Immediately following release of the audit report, case assignments were increased for all investigators from 20 to 25 each which aided in the elimination of the backlog. The BRN developed procedures requiring a case received by the investigations unit to be assigned to a Supervising Special Investigator (SSI) within 10 business days. The SSI is responsible for reviewing and triaging the incoming case workload of the unit. Cases will remain assigned to the SSI until the field investigator's workload allows the case to be assigned to the field investigator. This process has been updated and included in the policies and procedures for investigations. In addition, the BRN began strictly adhering to the Division of Investigation's CPEI case referral guidelines which has also contributed to elimination of the backlog.

BRN indicated that it eliminated its backlog of complaints awaiting assignment to an investigator by assigning them to its investigators. Based on documentation provided by BRN, this increased investigators' caseload, on average, to roughly 24. However, as we describe in our audit report on pages 28 to 29, the chief of investigations acknowledged that a full caseload for BRN's non-sworn investigators is 20 complaints. Therefore, rather than BRN eliminating its backlog, it simply shifted the backlogged complaints by assigning them to its non-sworn investigators who already have full caseloads. Until it can demonstrate that its non-sworn investigators are able to timely resolve complaints, given the increased caseload, we will report this as partially implemented.